Sex, Drugs & Science
Sex, Drugs & Science
Dave Humes: Naloxone Policy
Dave Humes is a Board Member and the Public Policy Coordinator of aTAcK addiction, a naloxone trainer, and co-chair of the Changing Perceptions and Stigma Subcommittee of the Behavioral Health Consortium In Delaware. Dave shares his story of losing his son to an opioid overdose, and how that inspired him to advocate for policy change surrounding access to naloxone (an opioid overdose-reversal medication) in Delaware. Valerie and Carly ask Dave for advice about advocating for policy change and Dave shares advice for scientists.
Learn more about aTAcK addiction here: https://www.attackaddiction.org/
Follow Dave on Twitter: @Gregs_Dad
Learn more about how naloxone laws changed between 2001 and 2017 through the Prescription Drug Policy System site: https://pdaps.org/
I'm Valerie Earnshaw.
Carly Hill:I'm Carly Hill,
Valerie Earnshaw:And this is sex drugs and science.
Carly Hill:Today's conversation is with Dave Humes, who is a board member of attack addiction, a local advocacy group, focused on addiction here in Delaware. He's a Naloxone trainer, a member of the drug overdose fatality review commission, and the co-chair of the Changing Perceptions and Stigma subcommittee of the behavioral health consortium in Delaware.
Valerie Earnshaw:Uh, Carly, I haven't told Dave this, but I have a lot of affection for him because he reminds me of like all of my uncles. I feel like I could count on Dave to tell dad jokes at a picnic or meet me on, you know, 95 or a local highway if my car broke down. So I don't know. Am I off base?
Carly Hill:No, I think Dave is way cooler! I wish Dave was my uncle actually.
Valerie Earnshaw:But then unlike my uncles, Steve spends his days distributing Naloxone all over our state, which is a medication that can reverse opioid overdoses and he has this like, you know, little interest in supervised consumption sites as a form of harm reductions, which is still like mega controversial. There are places where people can use drugs under supervision of medical professionals and there, you know, another strategy to prevent overdose stats. David's done a lot of work in Delaware and other states to get Naloxone policies passed. And now he's kind of turning to other policies to address the opioid crisis and reduce overdose rates. So we were really interested in getting to know Dave story and continuing our conversation this summer about the intersection of science and policy with him. So please enjoy this conversation with uncle Dave Humes, Dave Humes, welcome to the podcast. Thanks for joining us.
Dave Humes:Thank you, Carly. Thank you, Valerie. Thrilled to be here, to talk to you about some really important issues.
Valerie Earnshaw:So we have a lot of folks who aren't from Delaware, who listen so for the people who aren't Delaware. I just want them to know that we're chatting today with like a local superhero celebrity, especially in the area of--
Dave Humes:hardly.
Valerie Earnshaw:made a lot of good changes in our local opioid crisis. So, so Dave, for the folks who haven't had the benefit of attending one of your Naloxone trainings or reading about you in the paper, which Carly and I have both done both. Tell us a little bit just about your background and how you got involved in some of these issues surrounding the opioid crisis and recovery in Delaware.
Dave Humes:Absolutely I said it many times in public meetings. I like to steal a good quote when I can find one. And I like to start out, you know, to tell the listeners with a quote,"never doubt that a small group of thoughtful, concerned citizens can change the world". Indeed. It's the only thing that ever has. And as we talk today, I hope that your listeners will keep in mind. I'm really nobody special. I'm just a dad. And when I talk about our, our nonprofit organization Attack Addiction, I jokingly say we're just a bunch of dumb moms and dads trying to figure it out because we're not professionals at what we do, but you know, we try and find a way to get things done. So I'm a person in long-term recovery from alcohol and illegal drugs. I am not somebody who ever used heroin. And I don't say that because I would be embarrassed to say so I say that because I think it's a different type of addiction, a stronger type of addiction than all these other addictions. If we go back to Philip Seymour Hoffman, he's somebody who had been addicted to heroin had 20 years of sobriety and something drew him back and he overdosed and died. So again, I've been in recovery for a long time, but the thing that got me involved is I had two sons who were a year apart and they did absolutely everything together. They were playing sports teams together. They, they liked the same music and bands and went to concerts together and everything. And then my younger son, Greg, he started doing what people do as teenagers. You know, they are wired to experiment, to push limits, push boundaries and whatnot. And, but both my boys, you know, did a little experimentation. They, you know, they, they were doing mushrooms and they were smoking some weed and that sort of thing. And, but my son, Greg kept going and he started using other things such as cocaine, which is interesting because at the time we tried to get him into a rehab and they said, uh, you know, we can't take him because cocaine isn't addictive. Once it's out of your system, it's all gone. You know, if you had a problem with alcohol. So we said, oh yeah, we forgot about the alcohol problem. Just to get them into some sort of treatment. That's the way things were. And then it-- this goes back into about 2006, 2007, somewhere in there, you know? So anyhow, you know, his use progressed and he started using heroin. He was introduced to heroin, started smoking a little bit. And finally he ran into a lady friend and it's not her fault, but she introduced him to injecting and whatnot and to feed his habit, he got involved in some things he shouldn't have gotten involved in and ended up going to prison. And when I, what I have to tell everybody about Greg, is anybody who ever met him would describe him with one word. And that was sweet. You know, oftentimes we think of people who get addicted to these substances as being, you know, risk takers and whatnot. And what we found out along this journey, some of the other parents that have been involved as it's typically people who feel as if they don't fit in, who are quiet, more sensitive and whatnot. And that's why they turn to different drugs. So, Greg was really a sweet kid. He really was. And you know, here's somebody going to prison and they go, well, that doesn't sound so sweet to me, you know, but in effect it was, he served 21 months in prison. And when he was released, you know, we had the talks of course about, you know, not starting relationships and that sort of thing. Uh, you know, get yourself straight before you do that. Then, you know, he started a relationship and he, uh, ended up violating his parole and he went back to prison. His second stint in prison, it was, it was Rocky between he and I at first because he violated shortly before Christmas, you know, I was angry. And even though I knew about addiction or thought I knew about addiction, I still didn't know enough to understand about heroin and whatnot. So we, we were, you know, we were on icy terms at the time and they cooled, certainly, because again, the only thing you can really do is give your love and support to try to get them back on the right path. And it was while he was doing his second stint in prison. And he said, you know, I,"I coasted the first time around and he said, but I don't want to spend my life institutionalized, whether it be rehabilitation or correctional facilities". And he really got it at that time. He was in prison in Pennsylvania. He got released on parole to my wife and I, we had his parole transferred here to Delaware. Originally I'm originally from Pennsylvania and he was doing absolutely everything right in his life. He was exercising. He was very engaged with my wife and I. He wasn't, you know, he wasn't upstairs on the computer or on his phone, you know, we'd watch sporting events together. And, and he, you know, he was just very engaged with us. He'd go to bed early, get up early in the morning, do meditation, do some exercising. He was getting ready to participate in one of those mud runs for MS.
Valerie Earnshaw:Yeah! Like many early 20 year olds.
Dave Humes:He was completing his community service at the food bank of Delaware and whatnot. And he was doing everything absolutely right in his life. And he was gradually getting together with his old friends, because some people like to portray opioid addiction, heroin addiction, as a party drug, and nothing could be further from the truth. It's a drug of shame. And so it distances you from the good people in your life it distanced him from his brother who was so very close, but he was starting to get together again with the people who were the good guys in his life and getting reacclimated to normalizing his life. And we had conversations about different things. He was working for me at the time in a small business. He had a great aptitude for it. We spent a lot of hours in the car going to job sites, driving up to north Jersey and Virginia and that sort of thing, and talking about some things. And one of the things I had said to him was that I really felt that he should quit drinking as well, because he had never, you know, apparently had a problem, a drinking problem. But I thought I said to him, I said, you know, my fear is that some night you'll drink too much and clouds your judgment. You'll say, now I can do this again. And then you'll be off and running again. And what happened as he was reacclimating himself, he was out with some friends. That I knew that were the good guys in his life. And he bumped into some old running mates of his and, uh, you know clouded judgment. And he thought he could go out and do this one more time. And you know, when you, when you're away from opioids for awhile, you have a change in tolerance. And he tried to use what he had used before. And that decision proved to be fatal. And the people he was with, they lifted him up. They put them in his car. They drove him to the parking lot of a hospital and they simply walk away. They did not, they did not go to the emergency room doors and punch on that red button and run like crazy. They didn't hit the key fob to get the horn beeping and run away. They didn't go a block away and try to call and say,"Hey, go look in parking lot." They just, they just left them there. And by the time they discovered him, it was too late. They rushed him in and they tried to revive him, but he had been there too long. And in the aftermath I met with the investigating detective two days later, after, as a matter of fact, two days from now, Wednesday will mark, the ninth year, since he's been gone to the day. But two days later, I met with the investigating detective to reclaim his belongings, his car and that sort of thing. And the detective said to me, you know, if we had a 911 good Samaritan Law, or a Narcan Law, your son might very well be alive today.
Valerie Earnshaw:Oh okay.
Dave Humes:And those were the words that stuck with me, I was trying to decide what I was going to do. I had a small business at the time, and I talked to some people who advise me financially. If somebody says, they own a business, you know, they got an expensive car and everything. It was a small business. Let me tell you. We have a nice little townhouse, but again, nothing special. But I talked to some financial people and they said, you guys don't live high on the hog. You know, if, if you want to retire, now you can probably do it. So the goal was really to try to do something about this whole crisis at the time. And I made the decision to close down my business and people said to me,"you dummy, why didn't you sell it?" And I didn't show it because I didn't want to be involved in it anymore. And I knew I would have had to sign a contract, you know, for consulting for a number of periods. I decided really just to close it down because most of the business was in my head, 90% of it. So it took some time to close it down. I wanted to make sure, you know, I did things right. Didn't leave anybody out, hanging out there. Then that took me to October of 2012. And you know, I was ready to sort of jump into the fight, but Thanksgiving was coming up and I knew the first Thanksgiving would be extremely hard. It's always been my favorite holiday. You know, just immediate family, no presents, no cards, all that stuff. It's just family gatherings. And I said, I, I, you know, I better hold off, which I did. And during the course of closing down my business, the end of September, prior to being closed down, the local newspaper had a front page story on heroin. And I read that article and I folded it up and I put it in the corner of my desk. And I said, I'm going to get back to this. So in January of 2013, January 2nd, probably it was, I picked up that newspaper. I read through it, anybody who was quoted in there, I reached out and I contacted. And I was really fortunate because one of the people that had led me to the doorstep of Genie and Don Keester, who had started an organization here in Delaware called attack addiction. They had lost their son on December 23rd, 2012. You know, you think about that. If that's not bad enough, it was worse for them because it was also their daughter's birthday. That's what she has to live with in that time of year, every year. And then they started this organization within two months of the loss of their son, Tyler. And they started the organization, not as a support group, but as an open transparent action group, we were determined to do something. My Vow, after losing Greg, like vow to him, was to somehow save a life in his name. And I didn't care if I knew that person's name, I didn't care if they knew Greg's or my name. But the idea was to somehow save a life in his name. Of course, it's like, well, how do you do this?
Valerie Earnshaw:Sure.
Dave Humes:So what we decided to do at Attack Addiction was well we said, okay, what do we do? I brought up that quote from the detective."If we had a 9 1, 1 or a good Samaritan law. Some might very well be alive today" when we decided that would be a good idea at the time we were a small group. And the decision was whether we tried to get a bill passed with both of those things in there, or whether just go for one. And if we were just going to try for one how to go about it, which one should we select?
Valerie Earnshaw:Oh, this is, let me put a pause here because I have a million questions for you. And I'm so excited because, you know, to hear about the, you know, how you started working towards the, making these changes in the bills, but you started out. So first off, I just want to say that you started the story by saying that, you know, you're nobody special and I've just have got to disagree, you know, because as you're telling this story and I just, I want to say a huge thanks to you for sharing it, both, you know, here and Carly and I have heard you share it in other places as well. And I don't know what the experience of sharing that story is, but the experience for me of hearing your story, like every time I'm, teary-eyed, every time I'm, I'm super moved and it's such a powerful, it's a powerful story and it's, it must be hard to share it, but it's also such a gift for allowing people to hear more about the experience as you go along and tell it you're, you're busting stereotypes left and right. Like it's really amazing. And you're also underscoring some big problems, like, you know, something that jumped out to me on this one, just was that, you know, we've had a few conversations now around how we take a criminal justice approach rather than a public health approach towards addiction. And in this story, like, why is it that Greg landed in jail twice or, you know, circulates through prison, but he doesn't get care? Like you took him to care and he didn't get care. We talked last summer with a pediatrician, Scott Hanlon, who, who really highlighted for us, how we're lacking in treatment for young people. And so that's one thing that runs through my mind with this, but I also just, like, I personally resonate quite a bit with your story in terms of, well, first off I was born in Pennsylvania, moved to Delaware. So we both have that same, you know, migration pattern..
Dave Humes:We have that Commonwealth of knowledge.
Carly Hill:*ba dum tss*
Valerie Earnshaw:We have similar humor a pparently. And then I can also relate to just like getting really bad. Our family got really bad advice in the 2000's about addiction, you know, and about y eah. How to respond to it. And you know, what treatment options were available to us, we also have lost, you know, a family member to overdose. And so then I have to push back on you about this, like nothing special piece. I mean, in some ways, you know, many families have lost people to addiction. Many fathers have lost sons to overdose and not all of them have, you know, retired early and really thrown themselves into this movement. And it's amazing that you connected with another family, you know, you connected with the Keesters early on and found some folks were also doing that, but that's the only part of your story that I have to disagree with and push b ack o n.
Carly Hill:Well, that, and I was just gonna say, Dave, you've also, you know, saved more than, than one life for Greg too. I know that through your work with the Naloxone training and all that. So I have to agree that I think you were pretty wrong about the nothing special thing, but continue,
Dave Humes:You know, I, I say that because I want people to realize that they can step up and do this. Really. You know, if you step up, you can make these changes certainly. And you, it's interesting about saving a life it's... I wanted to save a life and then I got greedy, not enough.
Valerie Earnshaw:Best place to be greedy in!
Dave Humes:T hat, yeah. Yeah, y eah. And one of those saved through this w ork was my cousin,
Valerie Earnshaw:oh my God,
Dave Humes:I got a call from one of my cousins and said, you saved your cousin's life. I said, what are you talking about? And he said, the overdosed, they called 911, they administered Naloxone and he's alive. You know? So you hear that and you know it hits you certainly, it really hits you.
Valerie Earnshaw:All right. Well, let's return the wheel to you. You got us up to the part of the story where you've gotten together with the Keesters, you have formed to talk addiction, you're a board member of Attack Addiction, which is fantastic. And you're making a decision about whether to pursue just the Narcan access laws or the good Samaritan or both in combination. So could you, could you catch up folks who may not be familiar with Narcan? I know you're very familiar with t his. If you catch them u p j ust t o what that...
Dave Humes:So just very briefly about good Samaritan because that leads to the Naloxone. So our decision was to try to get a law, a 911 good Samaritan law, which would allow people to call 911 without being arrested, charged, or prosecuted, both the person who made the call and the person who was in medical distress. So it seemed to us,"that's a good idea. It doesn't cost the state any money, how can they object to that?" So that was really our strategy. But even to get there before you get to the 911 good Samaritan law, we have to go to the same sex marriage act. Because again, we were just a bunch of dumb moms and dads like, well,"how do you pass a law?" We know basically how to pass a law, but what's the actual process? What do you have to go through? So at the same time in 2013, Delaware was looking at passing, changing the law to allow same sex marriage that had been worked on from early on during the legislative session and actually passed through its final step at the end of April or early May of that year. So what we did is as a strategy, we looked at that bill and we looked at the members of the Senate, how they voted. We looked at the members of the house as they voted. And the people who were in favor of that bill, we thought would be sympathetic to our cause of the 911 good Samaritan law. And we thought we may have to do some further education to those who had voted against the same sex. So we took sort of a two-pronged approach and, you know, we shot to educate them as to why they should pass that bill. So, you know, ultimately we were successful passing it, the same sex marriage bill was a little bit over 50% vote in favor of it to pass that bill, both in the house and the Senate here in Delaware. And when we, it was just, it was so moving when we passed the good Samaritan bill, because in the Senate, we passed it unanimously. And then the house we did the same, there were three members who weren't present to vote, but Jewish, just really a very moving thing. So following the same sex marriage path into the 911 Good Samaritan bill, you know, led us to say, okay, we've done this. We've sorta learned how to go through this. Now we can try to get the Naloxone bill passed. So we, we used much of the same strategy that we had used before with the good Samaritan bill. And, you know, we, we found a champion and a sponsor. We actually had, uh, a bill written up by a lawyer that was specific to Delaware. And they said,"Eh do you want it sort of tight, or you want it really broad?" We said,"make it as broad as possible!" We can get it through broad, that's great. You know, if we have to make some concessions along the lines, you know, so be it. So anyhow, that was the following year in 2014. And again, we use that same strategy. We had our organization by that time was growing. We asked all of our members, we thought we were geniuses at the time. We're not the only ones should do this. We asked each of our members, we gave them some talking points. And what we asked them to do is put together an email to their own representatives. The first thing they want to say in that is they're a constituent and a registered voter in there and tell them why they were in favor of this bill. And we told them what we also wanted them to do is reach out to five other people and ask them to do the same, reach out, to-- have them reach out to five more. Through some of our studies and whatnot, it was our understanding that when you contact one of your state representatives, elected officials, that each contact represents about a hundred people. So you have to go wow on that."Never thought of that. I just thought I was just some dumb guy" you know, state Senator or whatever, you know, so, you know, it really has an impact. You know, we used, we put together a fact sheet about Naloxone and we told them, you know, it was FDA approved in 1971. It had no, you know, it could not be abused in any way, shape or form. Like some of the MAT could, you know, it was innert, it only affected opioids and didn't affect anything else. So if you gave it to somebody who was not in an opioid overdose, it would not help them, but it would not harm them. So we had this fact sheet that we made sure we send out to them to help pass the bill. And we were successful passing that one as well. We also sorta jumped in on with one of our representatives who were supportive. And at the same time, they had a bill that would allow all departments of peace officers in the state of Delaware to be trained in carrying Naloxone, local police couldn't just say at the time"we're going to carry Naloxone because it's going to save lives." You know, all departments had to be allowed to do it under Delaware law them to be able to do it. So that bill was also passed, you know, at that same point in time. So we have been involved and written the initial bill of anything, having to do with Naloxone in our state. So we've had several bills after that, that have been passed. We have one right now that awaits the governor's signature, we found out in Delaware, we have a behavioral health consortium that addresses mental health and addiction issues. And we have a subcommittee on changing perceptions and stigma. And as a result of our work on that committee, we found out that our original Naloxone bill did not grant immunity from liability for lay people administering it. So right now that passed both houses pretty readily. And we're just waiting to find out when the governor's going to sign that one.
Carly Hill:Can you tell our listeners a little bit more, when you say about the liability of administering Naloxone, can you tell us a little bit about that?
Dave Humes:Well, some of the bills that have been passed along the way and gave, you know, police officers liability from being sued for mis-administration of Naloxone. And it was a very important thing for them to have that some of those, those issues to me, it's like this can't hurt anybody. How can you mis-administer? You know, we look to try to find instances of where there had been allergic reactions or anything. And to this day, I haven't found one. I can't tell you, I spent, you know, 24 hours a day, day, you know, throughout the year looking for it, but we haven't been able to find that, but it came as a result because in our work with the subcommittee from the consortium, we went to some trade groups and said, you know, we were talking to them about their hiring policies for people who had had convictions for illegal drugs, what their policies were on treatment. If they discovered somebody who was in use and the end of the one meeting, I said, oh, by the way, if you ever want to have your folks trained out in the field, do use Naloxone. We're happy to do it because we know people in recovery gravitate toward the construction industry, to the restaurant industry and whatnot. And what we found out from that was that the companies, the construction companies, the restaurants and whatnot, they were in favor of it, but they said that their insurers were against it because they feared liability. And again, it's, you know, it's a matter of people not understanding that there's very little harm, you know, that you can receive from Naloxone and whatnot. So, you know, we talked to the insurance department, insurance departments at timeout, and that's a legal issue. Go talk to the department of justice. So we got in touch with the department of justice and they said, you know, actually that original bill does not have that liability protection in it. So you'd probably need a bill. So it was okay that you put together a bill and again, so we're just awaiting a signature on that. Right now, we still need additional protection against liabilities because the companies themselves would like it. And we get pushback from some organizations when it comes to immunity. So we have to be careful with language we have to try to, you know, put out a bill, that's going to be palatable to some of these organizations who are against it for various reasons.
Valerie Earnshaw:I'm so impressed, Dave, that this is already awaiting a signature. I feel like, I mean, maybe you've been-- hearing you talk about this liability issue, maybe you've been talking about it for longer than I'm aware of, but I feel like it was only a couple months ago where you, I was at one of these subcommittee meetings and you're like, oh,"we've figured out that this liability thing is a barrier to people wanting to get trained and to using Narcan." And so you were like,"we're going to try and change it", you know? And to me not, you know, it just feels like, you know, fast forward in time, maybe it's like a trick of COVID Timewarp or something, but it feels like fantastic progress. And it also almost in a way feels to me like it's reflecting the overall landscape of really rapidly changing policy in this area. I mean, it was only 2010 when there were only six states that even had a Naloxone access law and by 2017 all states had them. And so this is just, this is
Dave Humes:In varying degrees. Yeah.
Valerie Earnshaw:Is there anything more that you'd like to say about that or we're continuing to break down barriers? Yeah. Okay. Yeah. And it is interesting, like there's, we'll have to link to it Carly in the show notes, but there's actually a nice map that shows like how laws are changing and you're right. Like there's just the, you know, Naloxone access law, but then there's a whole bunch of other policies that people have had varying degrees of successes in passing that helps, you know, with access. So anyway, I'm just, before we got on this call, I was like,"Carly, like Dave's also working on some other policy. I forgot what it is. I'll have to ask about the status of that." So look at, look at you. Like it's just needing a signature that's great.
Dave Humes:Well, you know, it's, it's been interesting because this group of bunch of the moms and dads, since we've come into existence and you have to throw last year out, we've passed 17 bills, seven of them now over that time period, seven of them were specifically our bills. 10 of them were bills that we were heavily in support of, you know, made public comment before committee hearings and that sort of thing. And right now we have the liability bill and three others waiting for the governor to sign. We have a concurrent resolution that we're waiting to get passed. It's going to declare August 31st in Delaware, International Overdose Awareness day. And they're going to fly the flags at half staff in honor of all those people who have been lost. So, you know, the bills continue, but some of them go very quickly and some of them don't go so quickly. And then it was really interesting because when we look to pass the Good Samaritan bill, back in 2013, we were in June of the year. And for people out there Delaware only has a part time legislature. And they finish up at, at the end of June on June 30th and our bills, didn't start to go through committee till June. And there's only Tuesdays, Wednesdays and Thursdays are the days where legislature meets committee hearings, full legislature, whatever. And we're getting through a couple of them who I said to one of our champions on the bill, like"the end of June, we're about done here." I said, I said,"I guess we're going to have to wait until next year on this thing". And you know, I, I just remember her looking me in the eye and she said,"oh, we're going to pass this bill!" And I went, this is going to get done. And we had our, our final committee hearing on June 26 of that year. And usually from committee, then it goes to the floor of the respective house and the house agreed to suspend their rules, hold a special session so that they could vote on this bill and not have to bring all these parents who were there to support the bill back on another day. And you know, so here it went to the last minute and, you know, even, even our naloxone bill, the following year, which was passed at the end of June and I started calling June funnel month. Cause it seems like crazy. All the craziness of the legislative year, all funnels down to June, you know, no matter how early you start, but another bill that-- and I am most proud of the 911 Good Samaritan law that we passed here for, for a lot of different reasons, but, and I'm certainly proud of election access law-- But the other one that I'm really proud of that we passed in, in 2019 is Opioid Impact Fee Bill that took us four and a half years to pass. And it's a bill that puts a slight fee on the manufacturers of all opioids that are sold in the state of Delaware. And those fees go into a special fund stewardship fund to be used to help people who, I like to say, have been drug into addiction. You know, so Delaware was the first state in the nation to pass this bill. We had obviously a lot of pushback from a lot of representatives of the manufacturers of these opioids and we knew it was going to be difficult, but they're very proud of that bill and the state has now collected money. And you know, is looking to spend that money to help some of these people. So we're really, really proud of that one.
Valerie Earnshaw:Maybe this would be a good moment just to press, to take a beat and talk about the opioid crisis in Delaware specifically, and why it's important to do work in this area. So, Dave, I know you and I have been on some calls with the national Institute on drug abuse that has highlighted rates of overdose in Delaware. And we've also talked about this in some of our other episodes that are coming out this summer, but Delaware is, you know, we're the second smallest state I think in the nation, is that right? Carly's our native Delaware area expert.
Carly Hill:It is true, we are second behind Rhode Island.
Valerie Earnshaw:Thank you, Carly, but we are also second highest in rates of deaths for overdose. So Dave, you correct me if I'm wrong and getting this history about what looks like to me is that we were not doing well overall in overdoses, you know, through the 2010s, we were like creeping up. We were like for a while, it looks like we were hanging around 10th in the nation, but then fentanyl hits and around 2017, we really pull ahead. And then we're sort of up hovering with rates of overdose that are similar to west that are just after West Virginia. So it's like West Virginia Delaware, and then there's a gap. And then there's other states that at least for the 2019 data. And when I've dug into it just a little bit further, I see that, you know, so it looks like fentanyl is an issue here, which for folks listening, that's a synthetic opioid, it's just super duper powerful and it gets mixed in into that heroin, into the heroin supply. And so people don't necessarily know how much fentanyl they're getting and that can lead to overdose. But then I also saw that we had just recently over the weekend, I found a whole new report, the DEA report, which I, which is new to me. So I'll have to dig in further to that, but that's the Drug Enforcement Agency. And I saw that we also have really high rates of overdose due to cocaine, which circling back to Greg's story about like cocaine and addiction. I mean that, you know, that just makes me think that we don't, we're not taking cocaine seriously enough, but anyway, so in sum, my impression is we have always had an issue with overdose in Delaware. It seems to be getting worse, starting in 2017 when fentanyl comes onto the scene and it looks like we also are having an issue with overdose, like related to cocaine. So is that on track? What am I missing? Am I getting things wrong?
Dave Humes:No. You know, and I think really we started to, despite even prior to 2017, with the introduction to fentanyl. Fentanyl... when we talk about heroin here in the state of Delaware, one of our largest police forces is our New Castle County police force. And they told us that if you go back 15 years ago, the composition of heroin was such that it was 30% pure. The heroin that they are taking off the street over the last couple of years is 70% pure. And sometimes as high as 90% pure. So that's bad enough. But when we talk about fentanyl, fentanyl is 50 to a hundred times stronger than heroin. So I was talking to my son the other day and I said, you gotta help me with all these gigs and everything. I said, I understand miles per hour because I drive it, but help me out with the gigs. But so just to let people understand what fentanyl can do. If you took a package of sugar that you found in any coffee shop, there's approximately 300 grams of sugar in there. If that's fentanyl three grams can kill a person. So if you're in a room of a hundred people, a sugar packet of fentanyl can kill a hundred people. And if you're in Delaware, if you have a shoe box of fentanyl, you can take out the state.
Valerie Earnshaw:Oh, wow. That is powerful.
Dave Humes:That's how strong this is. So, you know, one of the things I just don't understand about the dealers are why do you try to kill your customers? Don't you want repeat business? And what the dealers are doing. They're mixing fentanyl in with heroin. They're mixing fentanyl in with cocaine, which is, this is what's in part leading cocaine, overdose deaths. They're putting the fentanyl in weed. Because the idea is they want to get people hooked. And so, you know, it's not FDA approved stuff, you're buying off the street, right? So the, the dealers are trying to get people hooked so that they're mixing the fentanyl in. And it, it's not just that they're mixing with other illegal drugs, but in many instances, what they're trying to do is they take the fentanyl and they mix it with fillers and whatnot and they buy pill presses and they make it look like oxy.
Valerie Earnshaw:Okay.
Dave Humes:So you have that whole thing going on with the fentanyl, you know, that has been really bad over the last three or four years. And again, that's a, that's a national thing. Certainly, certainly I think here in Delaware, I think 82% of the overdose deaths have some amount of fentanyl within the system. So it's obviously a huge problem.
Valerie Earnshaw:Yeah. And then, I mean, COVID has just made it worse. So, I mean, you talked about this a little bit earlier when you were talking about Greg's story, but just this... we, and we've talked about it also just this relationship between like social isolation and disconnection and overdose risk. So first, you know, people who are more socially isolated are at greater risk of opioid use and then opioid use leads to greater social isolation. And then the other problem with social isolation, I think you also like really hit this on the head when you said like heroin is not a party drug, like the part of a risk of overdose is using heroin or using these opioids by yourself. And as people have been socially isolated, as they've been more likely to be using these drugs at home, then that increases the risk of overdose. And I'm not sure what the numbers look like lately. We'll have to probably wait and see. But, you know, we were at a meeting earlier on in the epidemic where we saw the rates for Delaware and it just, it looked like very bad news bears looked pretty scary for increases in overdose in Delaware. So I'm sure we'll have to wait for the dust to settle, to find out more, but it's not going to be good.
Dave Humes:Yeah. Last may in Delaware, we tied for the greatest number of overdose deaths in a month. So that was certainly in part due to COVID and it looked as if that would put us on track to far exceed the overdoses from the prior year, we did exceed them, but not nearly as greatly as expected, I guess the good news in all of this is that our overdoses increased, but the rate of overdose decreased. So we are below double digits for the first time, since at least 2012.
Valerie Earnshaw:Oh, that's fantastic.
Dave Humes:Yeah. So that's good. You know, part of it we can attribute certainly to Naloxone to Narcan you know as we've changed some of these laws. You know, like in Dave's perfect world, I'd go buy a pickup truck and have Valerie drive around. And I'd be handing out Naloxone to everybody I saw, you know,
Valerie Earnshaw:Yeah. Can we do that full time? Like, can I turn retired?
Carly Hill:I'm down, I'll buy a trunk. Let's go.
Dave Humes:You know, so we are getting more out there. There's several organizations such as our organization that do community trainings. But I have to tell you, there are some instances I've, I've been critical of the state's effort in various things. But through this whole pandemic, they have done a really good job of getting Naloxone out into the hands of the public. And one of them, you know, one of the studies that we've done has been produced here in Delaware says that 79% of overdoses occur in a residence. Now it's not necessarily an overdose death. That's just an overdose, right. Of those 79% of residences where they occur, only 7% have Naloxone. So that's why it's important to get more and more of naloxone out there. The other thing that comes into play as well is with fentanyl. Typically when, when we distribute Naloxone, people get two doses. So if in the instance where one dose of Narcan isn't working after about five minutes, and you've tried a couple other things you give a second dose and hopefully that brings them up, you know, get some breathing, the respiration going again. But with fentanyl, it's so strong sometimes two don't do it. And we've heard instances where three, four and five, you know, administrations have been made. So even if you have your two doses, sometimes with fentanyl, you can still be in some tough situations.
Valerie Earnshaw:So Dave, I'd like to kind of, to close us out by thinking about if folks are listening and they're interested in making policy changes related to some of these issues in their state or their local communities, or maybe, you know, something else. I'm curious as to what kind of advice you might give to people who, who want to be like Dave and make some change.
Dave Humes:Well, the first thing is when it comes to, we've been calling this the public health crisis of the 21st century. And I'm still going to call it that despite COVID, because we're coming out of COVID and at some point within the next year, or, you know, hopefully we'll have it totally under control. We've been going through this opioid crisis for two decades now, you know, so that's why I call it the public health crisis of the 21st century. But the first thing to realize about this is you look down in Washington or you're looking in various states. This is one issue that is really a nonpartisan issue. And you get support from both political parties on it. You can't pass legislation unanimously, you know, if you don't have the support of both parties. So the first thing is to understand that this is a non-partisan issue to get involved, you know, get involved at the local levels is where you want to get involved. We're fortunate here in Delaware, as a small state, we can very easily be in touch with our elected officials or our state senators our state representatives. You know, I know in Pennsylvania it's more difficult. They have a very large legislature in Pennsylvania and they have some 250 legislators in PA. So, and PA is one of 10 legislatures that is considered full-time. So it's much more difficult, you know, in a, in a larger state, but you can still do it. When we passed our good Samaritan law here in Delaware, it was signed by the governor on July 2nd. And on that night, my wife and I went to dinner and I got up the next morning and I started making some phone calls in Pennsylvania, it's where Greg was born, right, spent most of his life. That's where the detective told me"we need a 911 or Good Samaritan law". That next morning, July 3rd, I started making phone calls to people in Pennsylvania. And we put together a coalition in Pennsylvania of nonprofit groups that we found in all corners of the state. And we put that together and it took longer because again, Pennsylvania has a large legislature. We started it in July. We started bringing people together. We finally passed a bill that incorporated both community access to Naloxone and 911 Good Samaritan, all in one bill. And it was finally signed by then governor Tom Corbett on September 30th, 2014. So we did it in little states and we did it in large states, but you know, what you really want to do is you want one to find out who your local legislators are. If you can, you know, you want to try and set up meetings with them. In some states, they have monthly, you know, constituent coffees, you know, which is you're going to be there with a bunch of people, but you're going to get some access and you're going to get some face time. Don't be afraid to seek them out, you know, send emails to them, trying to, you know, get a meeting with them. And, you know, you want to be respectful. I mean, everybody has their opinion of legislators sometimes, but you know, you want to be respectful because you know, most of them work very hard. They spend a lot of time off hours and whatnot, you know, doing things for your constituents and everything. So there are a couple of things that you can do. I think you want to try and touch base with your media. I think as you try to pass legislation in the instance of addiction issues, I always look at it as sort of a two-prong thing. I look at it as, you know, old poops like me and younger people. I get a lot of my information from the newspaper. So you want to hit new local newspapers, local media, and try to get them to cover these stories a little bit. And then you want to develop a social media platform so that you can reach, you know, younger generations. People might, you know, for instance, my son Dave's age, so you can reach them there, you start creating awareness. You know, of the problem, you know, there are a couple of things that you can do right off the bat. I always suggest that when you're looking at the media, you try to find their health reporters.
Valerie Earnshaw:Okay.
Dave Humes:Yeah. And every time we've tried to pass these laws, we, you know, a lot of instances in some states, they want to do it as a criminal justice issue. We've always tried to make it a health and social services or health and human services, a human issue rather than a law enforcement issue. But we all always want to build consensus with law enforcement. We've been fortunate here in Delaware. Our law enforcement has been very progressive in addressing this issue. And, and early on, I remember when a police chief saying we can't handcuff our way out of this. Again, a very large police department, New Castle County here in Delaware. They started a program a couple of years ago, it's called hero help. And if you need help with addiction issues, you can go into the police station, request help, and they will help you. As long as you have no serious charges against you, you have no major felonies. They will literally take you to detox. They will follow up. They will see about getting some post detox care and whatnot. So, you know, we're seeing a lot of progress on that front with law enforcement. So we we've been fortunate there, but you know, you want to build a coalition of partners and that includes both ends of the spectrum. You know, you want, you want to try and make friends with people who seemingly are opposed to these ideas.
Valerie Earnshaw:So this is super helpful, I mean, so I'm hearing a lot of coalition building I'm hearing like making direct contact with the policymakers who are representing you. I'm hearing, you know, earlier on in your story, when you were talking about crafting these emails, I'm hearing a lot about like sharing personal stories and reasons as well. You know, getting word out, educating your community. I'm curious as to how scientists who are, you know, local scientists like me, or, you know, scientists who might be really working in areas that you're trying to advocate around, maybe nationally, how they can be helpful for these, like for these efforts. And I'm also curious, you know, I know that you're, you know, you're pulling in great data and you're pulling in great science, like, as you are also advocating for these changes as well, and sort of, where are you finding that science? Like, how are you accessing that? Like along the way. Are scientists calling you Dave? We should be calling you...
Dave Humes:We do. And that's how you and I, you and I came into contact with one another. So it's time for Dave to pull out another one of his collection of quotes. I love this one,"nothing about us without us", early on, we saw policy being driven from the top down and policy needs to be driven from the trenches. Scientific data collection and whatnot needs to be driven from the trenches. You know, I've often said that with some of the policies coming down, people are sitting saying"this is what we think they need. Let's give it to them." And I said,"why don't you ask them what it is they need?" So, you know, it's the same thing with the science community, you know, what are things that are needed? What science can do. I think science can look into studies of how we recover. You know, let's take a look at different types of MAT, you know, Medical Assisted Treatment. Let's look at methadone, let's look at buprenorphine, let's look at naltrexone and let's look at abstinence. The four main things that are out there what's more effective. Can we find out one being more effective than the other? I volunteered for several years with an IOP group, which is intensive outpatient program. And it was mainly younger people who were sent there by the drug diversion courts and very un-scientific sample, certainly small sample size, just anecdotal my personal experience. The people who progressed best to the IOP to get their charges dropped and everything were the ones that were on naltrexone. And I just have a strange sample size there that seemed to work or, you know, is that applicable in real life? So that's an area that I would like to see more science involved. One of the big fights when we looked at Naloxone and it's still out there, you know, we hear, oh, when you administer Naloxone, you're going to wake up a raging beast and that person's going to come out of it and rip your heart out and whatnot. You know, things like that have been said by legislators, it's not an exact quote, but it's close. And my contention as a non-medical person. Is can this happen? Yeah certainly it can happen. But when we talk about the lay person, administration of naloxone like we're doing out in the community, this is relatively small dosages compared to somebody being taken care of medically and getting an IV of Naloxone, which may put them into a violent reaction. So I would love to see some studies there to show people. I've seen five abstracts, again, small sample size that basically say, does it happen? Yeah, but it only happens 7% of the time. As long as we're talking about a violent reaction where there's, you know, hands on, on somebody's shouting and screaming that you ruined their high is abusive, but you know, it's certainly not, you know, it's not violent. Another study I think that would be great from scientists is looking into safe injection sites.
Valerie Earnshaw:Yes, yeah
Dave Humes:When I talk about safe injection sites, I don't speak for our organization. I speak for myself on this one because we haven't decided how we're going to handle it. I'm in favor of safe injection sites. They've been doing it in Canada for quite a while. Now they have a pretty good track record. I think in, in 20 some years they have only lost one person to overdose in 20 years and you have to go"wow", there was, um, some, some of the listeners have probably heard about the Safe House in Philadelphia, who have been looking into establishing safe injection sites in Philadelphia. And I'm very pleased to say that here in Delaware, the attorney general joined Safe Houses in their suit to approve safe injection sites. So I think that's another area that could be studied. Several years ago, and I haven't done any follow up since, but there was a doctor at Scripps Institute out in California. I think his name was Dr. Janda and he was actually working on vaccines that people could be vaccinated against opioid addiction. And he also felt as if it could apply to alcohol and that sort of thing as well, where he is as far as clinical trials or as he got an approval of clinical trials. And, you know, if that's the science, we can, we can inject people at birth, to reject opioids or something like that. That's something else that certainly we can look into, but no, I, again, I just think it's really important to talk to the people who have gone through it, you know, to get their feedback and get their suggestions.
Valerie Earnshaw:I feel like you just mapped out like several careers worth of, of science for folks. So that's really helpful, you know, and to me, you know, what I'm really hearing here is a call for more like community engaged and maybe participatory action research is sometimes like what folks call this in the field, really this idea of, you know, you knocked it out with"nothing about us without us". That's a call that scientists have been hearing like for decades and in the HIV movement and in other areas. And I think it's so important for me to keep hearing that for others of us who are listening, who are scientists to keep hearing that because, you know, you don't get into studying this area just for fun, you get into studying this area and doing work in this area because you want to help people. And I think it's a really powerful thing to hear from you, Dave, that, well, if you want to be helpful for people, you have to talk to them to hear about what's going on in their lives and also to learn about, you know, how am I going to know what policy issues the movers and shakers are making in my, you know, in my area, unless I've talked to them and find out like, oh, there's some interest in, you know, and again, this is you, but i n safe injection sites, well, that's interesting. Like what can I do to be helpful in building an e vidence b ase that will help people to understand that this is a good thing. So that's really helpful. And it's a great call to action for folks who are listening. Dave, I really admire your leadership and your advocacy. I'm so glad that you got greedy with the l ife-saving like, it's just so tremendous. And I really can't wait to get this truck to go just full time, distributing Naloxone in Delaware. And t hen we're going to go up to Pennsylvania and just go like nationwide. I think that this is going to be tremendous.
Dave Humes:One last stolen quote.
Valerie Earnshaw:Okay. Yes, please.
Dave Humes:"The job of the citizen is to keep their mouth open" It's a quote from a gentleman by the name of Gunther Grass who is a German.
Valerie Earnshaw:What a good one. Will you please keep your mouth open and we'll do the same.
Carly Hill:We'll shout louder behind you, Dave. Thanks Dave.
Valerie Earnshaw:Thanks to the Stigma and Health Inequities lab at the University of Delaware for their help at the podcast, including Sarah Lopez, Molly Marine, James Wallace, and Ashley Roberts.
Carly Hill:Thanks to city girl for the music as always be sure to check us out on Instagram@sexdrugsscience, and stay up to date on new episodes by clicking subscribe.
Valerie Earnshaw:Thanks to all of you for listening.[Music]